Laparoscopic treatment of endometrioma-associated infertility and pregnancy outcome.

Ovarian endometriomas do not respond well to medical treatment with hormonal suppression, and surgical removal of the endometriomas is usually required. In this study, we attempt to identify the optimal laparoscopic procedures in laparoscopic treatment of ovarian-endometrioma-associated infertility. Among cases in which patients received no IVF-ET after the laparoscopic treatment, the pregnancy rate after complete cystectomy of endometriomas was statistically lower than that after fenestration with electrocoagulation of the cyst wall. Among cases in which patients received IVF-ET, there was no difference in ovarian response between patients that had complete cystectomy and fenestration with electrocoagulation of the cyst wall. However, the pregnancy rate in patients who had aspiration alone was statistically lower than that in patients who had aspiration followed by ethanol fixation. Thus, it appears that for patients who do not require follow-up IVF-ET, fenestration with electrocoagulation of the cyst wall is suitable, whereas for patients who need follow-up IVF-ET, ethanol fixation may be a better choice.